THE VALUED VOICE

DHS Announces Flexibility for Medicaid Telestroke Billing

The new billing clarification is consistent with WHA recommendations

Consistent with recommendations made by WHA to preserve alternate billing approaches for Medicaid telestroke services, the Wisconsin Department of Health Services (DHS) published a ForwardHealth Update last week to clarify flexible billing options for Medicaid telestroke services.

Telestroke enables a qualified stroke specialist to use technology to treat stroke patients in another location through a consultation with the patient’s local emergency providers.

In the ForwardHealth Update, DHS clarifies that Medicaid telestroke professional services may be billed either by:

• The provider delivering the telestroke services from a distant site to a patient located at a remote health care facility (called an “originating site”); or
• The originating site on behalf of the distant site provider delivering the telestroke services, provided the originating site has established a contractual relationship with the distant site provider for telestroke services.

The ForwardHealth Update further clarifies that if the originating site bills Medicaid for the telestroke services on behalf of the distant site provider, the originating site also may bill for a telehealth facility fee (called an “originating site fee”) as is currently allowed for originating sites under Medicaid’s telehealth policy.

DHS invited input from WHA as the agency developed its clarification on Medicaid telestroke billing, and WHA encouraged DHS to adopt the flexible approach of permitting either the distant site provider or the originating site to bill for the telestroke professional services.

See a comprehensive description of Medicaid’s telehealth policy. For more information, contact Andrew Brenton, WHA Assistant General Counsel, at 608-274-1820, or visit WHA’s telehealth webpage.